Abstract:
Aim: The objective of this study was to explore how selected sub-national (provincial) primary
healthcare units in Ethiopia responded to coronavirus disease 2019 (COVID-19) and what
impact these measures had on essential health services. Background: National-level responses
against the spread of COVID-19 and its consequences are well studied. However, data on
capacities and challenges of sub-national health systems in mitigating the impact of COVID-19
on essential health services are limited. In countries with decentralized health systems like
Ethiopia, a study of COVID-19 impacts on essential health services could inform government
bodies, partners, and providers to strengthen the response against the pandemic and document
lessons learned. Methods: We conducted a qualitative study, using a descriptive phenomenology
research design. A total of 59 health leaders across Ethiopia’s 10 regions and 2 administrative
cities were purposively selected to participate in key informant interviews. Data were collected
using a semi-structured interview guide translated into a local language. Interviews were
conducted in person or by phone. Coding of transcripts led to the development of categories
and themes, which were finalized upon agreement between two investigators. Data were
analysed using thematic analysis. Findings: Essential health services declined in the first months
of the pandemic, affecting maternal and child health including deliveries, immunization, family
planning services, and chronic disease services. Services declined due to patients’ and providers’
fear of contracting COVID-19, increased cost of transport, and reallocation of financial and
human resources to the various activities of the response. Authorities of local governments and
the health system responded to the pandemic immediately, capitalizing on multisectoral
support and redirecting resources; however, the intensity of the response declined as time
progressed. Future investments in health system hardware – health workers, supplies,
equipment, and infrastructure as well as carefully designed interventions and coordination are
needed to shore up the COVID-19 response.
